American journal of surgery · 2025
Exploring actionable targets to address disparities in thyroid cancer survival: A study of patients with aggressive variants of papillary thyroid cancer.
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Monreal Alberto J, Eze Anthony N, Thomas Samantha M, Johnson Kimberly S, Scheri Randall P, Kazaure Hadiza S
Аннотация
BACKGROUND: Despite compromised survival, disparities studies on aggressive variants of papillary thyroid cancer (PTC) are sparse.
METHODS: Using the NCDB (2004-20), adult Non-Hispanic Whites (NHW), Non-Hispanic Asians or Pacific Islanders (NHAPI), Hispanics, and Non-Hispanic Blacks (NHB) with aggressive variants were abstracted. Mortality risk was estimated using Hazard Ratios (HR).
RESULTS: NHB patients had larger tumors (p < 0.001) but lower thyroidectomy rates (p = 0.04). For all patients, cancer stage posed the strongest mortality risk (HRs Stage II-IV vs. Stage I: 2.75, 4.18, 8.04, p < 0.001), however, this was substantially higher by stage for NHBs (HRs Stage II-IV: 4.78, 7.57, 10.49, p < 0.001). Age ≥55 years was the strongest risk factor for Hispanics (p < 0.001); non-private insurance was the strongest risk factor for NHAPI, NHBs, and NHWs.
CONCLUSION: Beyond health insurance, actionable targets to improve PTC survival vary by race/ethnicity. For NHBs, higher clinical stage and worse survival by stage might indicate compromised access to optimal care. For Hispanics, improved follow-up, particularly for patients ≥55 years, may enhance survival.
METHODS: Using the NCDB (2004-20), adult Non-Hispanic Whites (NHW), Non-Hispanic Asians or Pacific Islanders (NHAPI), Hispanics, and Non-Hispanic Blacks (NHB) with aggressive variants were abstracted. Mortality risk was estimated using Hazard Ratios (HR).
RESULTS: NHB patients had larger tumors (p < 0.001) but lower thyroidectomy rates (p = 0.04). For all patients, cancer stage posed the strongest mortality risk (HRs Stage II-IV vs. Stage I: 2.75, 4.18, 8.04, p < 0.001), however, this was substantially higher by stage for NHBs (HRs Stage II-IV: 4.78, 7.57, 10.49, p < 0.001). Age ≥55 years was the strongest risk factor for Hispanics (p < 0.001); non-private insurance was the strongest risk factor for NHAPI, NHBs, and NHWs.
CONCLUSION: Beyond health insurance, actionable targets to improve PTC survival vary by race/ethnicity. For NHBs, higher clinical stage and worse survival by stage might indicate compromised access to optimal care. For Hispanics, improved follow-up, particularly for patients ≥55 years, may enhance survival.